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April 26, 2013

Cord Blood Transplant May Cure Boy With Leukemia of HIV

Physicians at the University of Minnesota have performed the first-ever attempt to cure a boy of HIV through a cord blood transplant to treat his acute lymphoblastic leukemia, the Minneapolis Star Tribune reports.

If successful, the treatment would essentially replicate the case of Timothy Brown, also known at the “Berlin Patient,” who was functionally cured of HIV in 2007. When Brown received a bone marrow transplant to treat his leukemia, doctors chose a donor with a rare genetic abnormality that blocks HIV from latching onto the CD4 cell’s CCR5 receptor. Essentially, the procedure gave Brown a new immune system resistant to HIV.

Replicating Brown’s success is highly challenging considering the difficulty of finding a bone marrow donor match who also has the HIV-resistant genetic abnormality, which is found in less than 1 percent of the population. This latest attempt at a cure seeks to work around that challenge by using cord blood, which is extracted from the placenta after a baby’s birth and then banked. Cord blood requires less specific genetic matching, so it is easier to find a bone marrow donor from such samples. The boy’s physicians have found a match that contains the genetic abnormality, called CCR5Δ32.

“What we’re attempting is a first and potentially landmark case for the HIV/AIDS community,” the University of Minnesota’s John Wagner, MD, a stem cell transplant expert, said in a release. “This now offers patients with HIV and leukemia or lymphoma new hope. But even more importantly, this should compel cord blood banks worldwide to identify how many cord blood units with CCR5Δ32 exist within the inventory. We also hope this case prompts others to find novel ways to block or alter CCR5 to mimic this protective variant.”
Following a week of high-dose chemotherapy and radiation to wipe out his immune system, bone marrow and, hopefully, leukemia, the boy, whom the university calls “Patient 2,” received the cord blood transplant on April 23, intended to infuse him with the donor’s immune system. The subsequent 100 days will be tenuous for the boy, as the severe treatment may also cause organ damage. The boy will continue to take antiretrovirals for HIV, but his physicians intend to take him off therapy after “several weeks to a few months” to see if the boy has been functionally cured, or if the virus rebounds.

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